Infect Control Hosp Epidemiol. 2021 Jul 26:1-28. doi: 10.1017/ice.2021.341. Online ahead of print.
BACKGROUND: We sought to determine the incidence of community-onset and hospital-acquired co-infection in patients hospitalized with COVID-19 and evaluate associated predictors and outcomes.
METHODS: Multicenter retrospective cohort study of patients hospitalized for COVID-19, 3/2020 to 8/2020, across 38 Michigan hospitals assessed for prevalence, predictors, and outcomes of community-onset or hospital-acquired co-infection. In-hospital and 60-day mortality, readmission, discharge to long-term care facility (LTCF), and mechanical ventilation duration, were assessed for patients with vs. without co-infection.
RESULTS: Of 2205 patients with COVID-19, 6.4% (N=141) had a co-infection (3.0% community-onset, 3.4% hospital-acquired). 64.9% of patients without co-infection received antibiotics. Community-onset co-infection predictors include admission from LTCF (OR 3.98, 95% CI 2.34-6.76, p<0.001) and admission to intensive care (OR 4.34, 95% CI 2.87-6.55, p<0.001). Hospital-acquired co-infection predictors include fever (OR 2.46, 95% CI 1.15-5.27, p=0.02) and advanced respiratory support (OR 40.72, 95% CI 13.49-122.93, p<0.001). Patients with (vs. without) community-onset co-infection had longer mechanical ventilation (OR 3.31, 95% CI 1.67-6.56, p=0.001) and higher in-hospital (OR 1.90, 95% CI 1.06-3.40 p=0.03) and 60-day mortality (OR 1.86, 95% CI 1.05-3.29 p=0.03). Patients with (vs. without) hospital-acquired co-infection had higher discharge to LTCF (OR 8.48, 95%CI 3.30-21.76 p<0.001), in-hospital (OR 4.17, 95% CI 2.37-7.33, p=<.001) and 60-day mortality (OR 3.66, 95% CI 2.11-6.33, p=<.001).
CONCLUSION: Despite community-onset and hospital-acquired co-infection being uncommon, most patients hospitalized with COVID-19 received antibiotics. Admission from LTCF and to ICU were associated with increased risk of community-onset co-infection. Future work should prospectively validate predictors of COVID-19 co-infection to facilitate antibiotic reduction.